Provider Demographics
NPI:1164436150
Name:KASSAB, MOAWIA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MOAWIA
Middle Name:
Last Name:KASSAB
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W WISCONSIN AVE
Mailing Address - Street 2:MARQUETTE UNIVERSITY, DENTAL SCHOOL, SURGICAL SCIENCES
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2186
Mailing Address - Country:US
Mailing Address - Phone:414-288-0771
Mailing Address - Fax:414-288-8392
Practice Address - Street 1:1801 W WISCONSIN AVE
Practice Address - Street 2:MARQUETTE UNIVERSITY, DENTAL SCHOOL, SURGICAL SCIENCES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2186
Practice Address - Country:US
Practice Address - Phone:414-288-0771
Practice Address - Fax:414-288-8392
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11-8751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics